Dallas Ebola case shows how health-care workers are at the greatest risk

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There was another grim reminder Sunday that health-care workers are those at highest risk of contracting Ebola from infected patients.

A nurse at Texas Health Presbyterian Hospital in Dallas tested positive for the deadly virus, just days after a nursing assistant at Carlos III Hospital in Madrid was found to be infected.

In both cases, they were caring for patients who had travelled from West Africa and were known to be infected with Ebola. As a result, care providers wore full protective equipment – gloves, gown, mask and shield – and were subject to disinfection protocols designed to prevent the spread of the virus.

So what went wrong? Most likely, human error, a small slip-up that the virus exploited.

In both cases, it is believed the workers breached the protocols – meaning they skipped or skimmed over a step in the elaborate set of rules designed to keep them safe.

In fact, the most likely scenario is the workers were infected while removing their protective equipment, the most high-risk part of the protocol.

Another possibility being investigated in the Dallas case is that the nurse was infected during a procedure such as intubation or dialysis, where there would be much more exposure to bodily fluids, and hence the virus.

Ebola is not airborne; it is spread only by direct contact with bodily fluids, such as blood and vomit. Infected patients bleed profusely and because of fever, vomit often in advanced stages of the disease, so they shed a lot of virus, especially if they are poked and prodded.

When caring for patients with infectious diseases such as Ebola, there is a detailed protocol for donning and removing personal protective equipment that should be carried out in an anteroom away from the patients, and in the presence of a "buddy" to ensure nothing is missed.

In both the Madrid and Dallas hospitals, it is unclear whether the buddy system was employed; all health workers who cared for the patients are now being isolated and monitored because it is likely that, if one worker breached the protocol, others did too.

These unfortunate and unexpected infections offer up an age-old lesson: It's pretty easy to devise rules (such as infection control protocols) but it's a lot more difficult to get people to comply with them, especially if they require tedious, time-consuming rituals.

We should, however, be careful to not simply point fingers of blame at the front-line workers. No one, least of all a nurse caring for a patient with Ebola, is unaware of the risks.

But front-line workers such as nurses are under tremendous stress and pressure, especially when dealing with a rare disease they have likely never seen and a case that is in the international media spotlight.

When you're desperately needed down the hall to care for another patient, would you rush to remove your protective equipment? If an Ebola patient bled all over you, would you be eager to get out of your blood-soaked gear? These scenarios are not difficult to imagine.

Health officials in the United States, up to and including Tom Frieden, the director of the Centers for Disease Control and Prevention (CDC), have been shaken by the case of the Dallas nurse.

Despite the fact that more than 416 health workers in West Africa have contracted Ebola, including 233 who have died, there were assurances that this couldn't happen in a country with the best medical facilities on Earth.

Now that it has, hospitals in the United States and Europe (and Canada, where an Ebola case remains a slim, but real, possibility) have to step up their game.

In the coming days, the CDC will likely revise its infection prevention and control recommendations. It will certainly urge hospitals to review the rules, step up training and learn from the mistakes made in Dallas.

It may call for staff treating Ebola patients to wear full hazmat suits, but that can have serious economic consequences, because workers generally can't spend more than an hour at a time in the suits, and the donning and disrobing protocol is even more elaborate.

Finally, the CDC will likely refer all future cases to specialized facilities such as Emory University Hospital in Atlanta, where three Ebola patients have been successfully treated.

But, as with all Ebola stories these days, we have to try to maintain perspective.

In this instance, the infection of a health worker should not make us more frightened of Ebola, because it is still a rarity that gets very special treatment.

Rather, it should remind us that workers in health-care settings – nurses, physicians, technicians, janitors – face hazards from myriad infectious diseases every single day. They put themselves on the line for patients with very little recognition.

Health workers have to be vigilant with Ebola, and much else, but they are only human.

So let's protect them as best we can, and appreciate them more than we do.